FLRA Partnership Survey Question Title * 1. Which of the following best describes you? (You may choose more than one response) I am a caregiver I am a care recipient I am a representative of an organization Question Title * 2. Please provide your contact information: Name Organization Title Address City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 3. Florida County of Residence: Alachua Baker Bay Bradford Brevard Broward Calhoun Charlotte Citrus Clay Collier Columbia DeSoto Dixie Duval Escambia Flagler Franklin Gadsden Gilchrist Glades Gulf Hamilton Hardee Hendry Hernando Highlands Hillsborough Holmes Indian River Jackson Jefferson Lafayette Lake Lee Leon Levy Liberty Madison Manatee Marion Martin Miami-Dade Monroe Nassau Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk Putnam Santa Rosa Sarasota Seminole St. Johns St. Lucie Sumter Suwannee Taylor Union Volusia Wakulla Walton Washington Question Title * 4. I am interested in partnering with FLRA in the following way(s)- check as many as you choose; you may update at any time As a member organization of the Florida Lifespan Respite Alliance As an individual member of the Florida Lifespan Respite Alliance As a member of the Lifespan Respite Advisory Group As a member/ leader of a regional respite committee Contribute information to be included on the FLRA website and social media Write guest blogs Question Title * 5. I would like the following information from the FLRA: Done